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What are the midwife’s tasks before, during and after birth?

Midwives help women during pregnancy, deliver babies and are still there for mother and child after birth. But how do pregnant women actually find the right midwife? And is it possible to do without one? Tikbow spoke with a midwife about the most important questions.

Pregnancy, birth, going home with the baby – these are exciting and often stressful times. Especially if it’s the first time. However, many women still ask themselves the question: Why do I need a midwife at all, which examinations does she perform and for which do I go to a specialist?

A midwife is not a must, but an offer

According to the German Midwives Association, there are around 24,000 midwives in Germany (as of 2017). However, on average 30 times more babies are born each year – this means that one midwife looks after several women at the same time. "However, a woman is not obliged to take a midwife", Claudia Rheinbay emphasizes. She is head of the delivery room at Vivantes Auguste-Viktoria-Klinikum in Berlin and has been a midwife for over 30 years. It is an offer from the health insurance companies and a great privilege in Germany that women can get help during pregnancy and for aftercare without having to pay anything,” says Rheinbay. "That kind of thing doesnüt exist everywhere. In the United States, for example, health insurers do not cover the costs. Women there have to pay for everything out of their own pockets. If you can’t afford it, you’re on your own;

These costs are covered by the midwife.

The health insurance companies cover the costs of birth preparation courses, preventive examinations, the first meeting and visits during the postpartum period, explains Claudia Rheinbay. "Follow-up care can extend üover eight weeks. A midwife can arrange for a mother to receive care beyond that time. This may be necessary, for example, if she has twins or a premature baby at home. In this case, too, the costs are covered by health insurance;

Many midwives work freelance. Some have a permanent part-time position at a hospital and offer other services on a freelance basis. Additional services, such as yoga classes, usually have to be paid for.

Prevention: Tasks of a midwife

A midwife is allowed to perform almost all the preventive examinations specified in the maternity passport, check the women’s blood pressure, check the baby’s heart rate. The pregnant woman is free to decide whether the midwife or the doctor should do this,” explains Claudia Rheinbay. However, there are a few preventive examinations that a midwife does not perform. These include, for example, ultrasound examinations, which are only performed in the doctor’s office.

Woman with baby and midwife
Breastfeeding, weight control of the baby, postpartum – the midwife is also irreplaceable postnatally.Photo: Getty Images

From her long experience, the midwife knows that the exchange during pregnancy can be very valuable for the expectant mothers. "Sometimes women still have questions after a visit to the doctor, for example about gestational diabetes. They can discuss these with the midwife and get a second opinion at the same time," Claudia Rheinbay explains. A midwife comes to the women at home, which creates trust and comfort;

Birth – what midwives are allowed to do, what they are not allowed to do

In Germany, only midwives are allowed by law to give birth on their own. Doctors are not allowed to do this unless there is an emergency. "So if everything goes normally, the midwife alone takes care of the birth", Claudia Rheinbay explains. "But every midwife knows when she has to call in a doctor. This is clearly regulated and part of midwifery training." This can be the case, for example, if something is wrong with the baby’s heartbeat. "Doctors must also be called if a birth has to be ended surgically. Midwives are not allowed to use a suction cup or perform a cesarean section,” says Rheinbay.

These examinations are done by the midwife

Once the birth is over, the baby or babies go home. How quickly that happens depends in part on the birth. The length of stay for vaginal births is about three days, for cesarean sections it is five days. Many questions also leave the clinic just a few hours after the birth," says Claudia Rheinbay.

The small postpartum period covers the first ten to 14 days after birth. During this time, the midwife usually checks on the mother and child every day,” explains the nursery manager. She asks about the progress of the post-partum hemorrhage, monitors the mother’s R&R and provides assistance with breastfeeding. The latter is a very sensitive topic, as Rheinbay knows: “Mother and child first have to adjust to each other, which is not always easy. Many questions arise for the mothers only when they come home with their child. A midwife gives tips if the milk does not come in, the child does not accept the breast or the nipple becomes inflamed;

In addition to breastfeeding, an important topic in postpartum care is newborn jaundice. "Babies were previously cared for in the womb and now have to metabolize food themselves. This can lead to so-called newborn jaundice," warns Rheinbay. "A midwife knows about this and has an eye on it." In addition, midwives help the mother to create structures for everyday life: "Midwives may also prescribe household help if they see a need", says Rheinbay.

Finding the right midwife

If you want the support of a midwife, you should start looking for one after the first trimester of pregnancy. The search is not always easy and midwives are often booked up for a long time. "If a home birth is planned, midwife and pregnant woman usually get to know each other earlier, usually in the twölfte week", says Claudia Rheinbay.  

The head of the hospital has a few tips for this: "Many medical practices have flyers from midwives on display. There are also online platforms such as ammely that provide midwives;

Once you have made contact with a midwife, you meet for a first meeting. "That’s when you see if you fit together", says Rheinbay. "If it should not harmonize, the pregnant woman can change the midwife also again"

How to become a midwife

Since January 1, 2020, it is no longer sufficient to attend a midwifery school. To become a midwife, you must complete a bachelor’s degree. This currently takes at least three and a half years and includes at least 2200 hours of theory and at least 2200 hours of practice. To study, you usually need a high school diploma or a completed training as a nurse. Detailed information is available from the relevant universities.